Universität zu Köln

Kottlors, Jonathan, Maus, Volker, Mpotsaris, Anastasios ORCID: 0000-0002-1275-8164, Onur, Ozgur A., Liebig, Thomas, Kabbasch, Christoph and Borggrefe, Jan ORCID: 0000-0003-2908-7560 (2018). Thrombus Enhancement Is a Predictor of Clinical Outcome in Acute Ischemic Stroke after Mechanical Thrombectomy. Cerebrovasc. Dis., 46 (5-6). S. 270 - 279. BASEL: KARGER. ISSN 1421-9786

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Abstract

Background: Ex vivo computed tomography (CT) studies of artificial blood thrombi showed that contrast enhancement (CE) is determined by fibrin-content, while unenhanced density is associated with red blood cells. Thus, the present study investigates patient outcome in association with combined thrombus density measures in native and contrast-enhanced CT (CECT) of acute ischemic stroke patients. Methods: This retrospective study includes 137 patients with MT occlusions treated by mechanical thrombectomy (MT) between 2010 and 2016. Clinical outcome was determined with modified Rankin Scale (mRS) at 90 days. Differentiation of complete and incomplete large vessel occlusion (CLVO/ILVO) was based on CT and angiography. Two blinded readers classified blood thrombi based on native non-enhanced CT (NECT) as (a) hypo-, (b) iso-, and (c) hyperdense and in CECT angio measurements as (d) not-enhancing, (e) intermediate and (f) enhancing. To make sure that the mean is not represented in any of the maximum/minimum groups, thresholds in both cases were selected in a way that all values within one SD around the mean value form the isodense/intermediate group. In addition, the CE per se was correlated with the outcome. Correlations between imaging and clinical scales were performed with Spearman's Rho. For the group testing Pearson chi-square test, Mann-Whitney U, as well parametric and nonparametric one-factor ANOVA Kruskal-Wallis test including Bonferroni correction for multiple tests ware used. Results: Twenty-three patients with ILVO (16.8%) differed significantly from patients with CLVO in mRS at admission (median 4 vs. 5) and after 90 days (median 1 vs. 4; p < 0.05) and thus were excluded. In the ILVO cohort, the classification according to NECT did not show statistical difference between hypo-, iso-and hyperdense CLVOs in regard to outcome. Classification of CLVOs according to CECT allowed an outcome prediction between the intermediate (median 3) and enhancing group (median 5) and between the enhancing and non-enhancing group (median 3; both p < 0.05) with a correlation of 291 between CE and higher mRS after 90 days (p < 0.005). Conclusions: CE of thrombiespecially in a range from over 18.4 to 40.35 Hounsfield Unitsis an independent predictor of poor clinical outcome in patients undergoing MT due to acute middle cerebral artery occlusion. (c) 2019 S. Karger AG, Basel

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kottlors, Jonathan UNSPECIFIED UNSPECIFIED UNSPECIFIED Maus, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Mpotsaris, Anastasios UNSPECIFIED orcid.org/0000-0002-1275-8164 UNSPECIFIED Onur, Ozgur A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Liebig, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Borggrefe, Jan UNSPECIFIED orcid.org/0000-0003-2908-7560 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-199556
DOI:	10.1159/000495419
Journal or Publication Title:	Cerebrovasc. Dis.
Volume:	46
Number:	5-6
Page Range:	S. 270 - 279
Date:	2018
Publisher:	KARGER
Place of Publication:	BASEL
ISSN:	1421-9786
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MIDDLE CEREBRAL-ARTERY; SUCCESSFUL RECANALIZATION; CT; VESSEL; OCCLUSION; DENSITY; IMPACT; SIGN Multiple languages Clinical Neurology; Peripheral Vascular Disease Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19955